Archive for March, 2013

Health Wonk Review: “Why hasn’t spring sprung?” edition

Thursday, March 28th, 2013

We open this weeks edition of Health Wonk Review with a breaking news alert: The criminal indictment against Punxsutawney Phil has been dropped. Despite the fact that spring appears elusive, the rascally rodent won’t have to look for his shadow from a jail cell next year. The Ohio prosecutor who filed suit says that he is done with animal cases, inviting some other prosecutor to take on the Easter Bunny. There may well be grounds for suit – check out the hilarious Sketchy Bunny site.
We couldn’t help but think of the other Groundhog Day when we read Joe Paduda’s post taking on the tin-foil hat brigade. He tries to put one myth to rest at Managed Care Matters: there is NO OBAMACARE RFID CHIP! We suspect that RFID chips are on the same continuous loop as death panels, and that no amount of dispute will put them to rest.
Leaving behind the Easter Bunny, the RFID chip and other myths, we think prosecutors should stop worrying about dereliction of duty on the part of groundhogs and perhaps turn their sights instead to more serious matters, like dereliction of duty on the part of our elected officials. Surely there is something criminal about the ongoing gridlock in DC, no? Which brings us to a jumping off point for this weeks edition.
At HealthBeat, Maggie Mahar takes on the sequestration, looking at what it means for health, education and the exchanges. Will “Looking Stupid” eventually motivate legislators to compromise? (Editorial note: that ship has probably already sailed over the horizon.) Maggie offers her thoughts on why the GOP won’t compromise on taxes.
Wendell Potter had a chance to see some of the DC action up close and he appears less than impressed. At Blog, he describes his testimony at an ‘Unaffordable’ congressional hearing, where he learned that House Majority lawmakers wanted to hear only that reform law makes health insurance unaffordable.
On the issue of affordability, Anthony Wright of Health Access Blog says don’t believe rate projections about how health insurance rates might go up because there are a number of variables these projections don’t take into account. And he notes that because everyone is starting from a different place, the impact will likely be different: Lots of people will pay less; some will pay more.
John Goodman isn’t buying any of it. In his post Bait and Switch at his Health Policy Blog, he strongly disputes the administration’s budget projections on health reform.
We pause in this edition to bring you a timely public service announcement: Louise Norris of Colorado Health Insurance Insider is thinking about the looming tax deadline and a few technicalities that might help to prevent uncomfortable moments in a tax audit. She reminds us that you have to have an HSA Qualified Health Plan in order to set up an HSA – something that many people wouldn’t know if they set up their HSA through a financial institution rather than through their health insurance carrier.
A deeper dive into costs
At The Hospitalist Leader, Bradley Flansbaum explains that an AHQR-sponsored database examines both commercial and government health costs, allowing an analysis of measurements in a comparative manner. In his post HCUP: Hospital Costs, Not Prices, he looks at inpatient costs and payers.
Are regions with above average Medicare spending per beneficiary more likely to provide high quality care? Are regions with above average Medicare spending per beneficiary likely to have above average Medicaid spending per beneficiary? Healthcare Economist Jason Shafrin provides an overview of his report written for the Institute of Medicine: Geographic Variation in Health Care Spending
Henry Stern of InsureBlog looks at the reception one employer’s attempt to rein in health insurance costs. CVS implemented a a health-screening program for its covered employees, causing some to cry foul. In his post Paying The Piper, Hank calls such protests out as hypocritical.
In his post at the Interdisciplinary Nursing Quality Research Initiative’s blog, Mark Pauly looks at the the challenging business case in which spending more on nurses improves quality, but wonders whether even when a more costly program passes the cost-benefit test, we be confident that buyers will be willing to pay for those costs.
The next generation
Much attention is given to the health care system, much less so to the educational institutions that breed future health care leaders. Roy Poses picks up the slack. At Health Care Renewal, he discusses the recent NYU Faculty No Confidence Vote in their President – another sign that, “faculty at large American universities, in which most of the country’s medical schools and teaching hospitals are embedded, are becoming increasingly concerned about the leadership and governance of their organizations, and whether the universities are putting their academic (and clinical) missions ahead of other concerns, like making money and rewarding top executives.”
At Wing of Zock, James E. Lewis looks at the projected physician shortage and asks, “Even if new and larger medical schools accept enough students to abate the projected physician shortage in this country, where will we get the clinical faculty to teach them?
Technology may save us
Health Business Blog’s David Williams recently attended HIMSS (Healthcare Information and Management Systems Society, for the uninitiated), where he interviewed Kaiser CIO Phil Fasano about Transforming Health Care, his new book. Fasano believes health IT can help empower consumers and can completely transform the relationship between patients and providers.
At Healthcare Talent Transformation, Jonena Relth thinks there’s untapped potential in technology. She asks why EMRs aren’t making use of existing technologies to improve care delivery in her post How come Spock’s computer was so far advanced beyond today’s EMRs?
In closing
Here at Workers’ Comp Insider, we focused more on the past than the present, taking a look at obsolete occupational maladies such as Bagpiper’s Fungus and Cheesewasher’s Lung.
Here’s wishing you all a happy holiday weekend and an imminent shift to spring-like weather. Watch out for sketchy bunnies and check back to Health Wonk Review on April 12, when our friends at Colorado Health Insurance Insider will host.

Annals of Compensability: (Lack of) Education Pays

Tuesday, March 26th, 2013

Imagine identical injuries to two workers: one is a junior college graduate, the other lacks a high school diploma;one can read and compute fairly well, the other reads at the 8th grade level and performs math at the 6th grade level. The injury involves failed back syndrome, with the injured worker experiencing fairly constant pain and the inability to perform sustained physical work.
In the world of workers comp, the first worker is deemed “employable” and entitled to temporary total benefits, followed (in some states) with a lump sum settlement for permanent loss of function. The second worker, lacking the education and skills to transfer to another job, is awarded permanent total disability benefits. In the two claims involving identical injuries, a marginal education pays.
For many years, Missouri resident Todd Grauberger worked for Atlas Van Lines, moving furniture and household goods. He performed heavy lifting routinely, avoiding physically demanding work only when driving from pick up point A to delivery point B. Ironically, his injury did not involve heavy lifting: in December 2001, he bent over to put padding on a nightstand – something virtually anyone could do – and felt an immediate pain in his back. His herniated disc required surgery. Even after some minor improvements, he continued to suffer from substantial pain and numbness in his legs. He was diagnosed with a phrase that terrifies any injured worker – and any claims adjuster: “failed back syndrome.”
Grauberger filed for permanent total disability benefits. His employer countered with a vocational rehabilitation assessment that concluded – without directly interviewing Grauberger – that he could perform light factory work or perhaps drive a car or truck. But the claimant’s doctor countered that with a failed back and almost no transferable (non-physical) skills, Grauberger was unemployable for any position that he might be qualified to hold. In other words, his only employable asset was the labor of his body and his body was irreparably broken. In a unanimous decision, the Court of Appeals in Missouri sided with Grauberger and upheld the award of permanent total benefits.
Hiring Conundrum
Employers do not give much thought to transferable skills when they hire new employees. They simply hire people qualified to do the work. Indeed, for jobs requiring sheer physical strength, it is often cheaper to hire the lowest skilled available workers. But workers comp, long the great equalizer, takes a post-injury look at employability. Once maximum medical improvement has been reached, the issue for workers comp is simple: the worker is either employable or not. If employable, benefits come to an end. If there are no transferable skills and no reasonable prospect of employment, the benefits may continue for the lifetime of the worker.
Grauberger will never again have to worry about finding gainful employment. Because he can offer nothing of value to the labor market, and because of his persistent, debilitating pain, he will be supported by workers comp indefinitely. It’s an odd calculus, seemingly rewarding the absence of marketable skills beyond the strength in one’s body. In this Missouri case, limited skills and limited education secure a future well beyond the reach of a failed back and a failing body.

Bagpiper’s Fungus, Cheesewasher’s Lung & other obsolete occupational maladies

Friday, March 22nd, 2013

Did you ever hear of rose gardener’s disease, nun’s chastity of fiddler’s neck?
All apparent names for occupational maladies of yesteryear. Watch this fascinating short video clip charting 10 strange occupational hazards.
Some of these conditions are associated with professions that are confined to the dustbins of history – becoming a loblolly boy isn’t a career path for young boys anymore. And some of these conditions may still exist, they are likely just rebranded. Others may have just adapted to modern tastes – cheesemaker’s lung may be largely a hazard of the past, but unfortunately, Popcorn Lung is not.

News roundup: risk, happiness, state fund in Illinois, new hire compliance & more

Wednesday, March 20th, 2013

Risk Roundup – Check out this week’s Cavalcade of Risk #179 – March 20th, 2013 Edition posted at My Personal Finance Journey
Taking care of business – At WorkCompWire, Joe Paduda poses the question What business are you in?” He hazards a guess that most of us would say “the insurance business” but he argues that we are really in “the medical and disability management business – with medical listed first in order of priority.” He suggests that, “Senior management misunderstands their core deliverable – they think it is providing financial protection from industrial accidents, when in reality it is preventing losses and delivering quality medical care designed to return injured workers to maximum functionality.” We could quote the whole thing, he makes a compelling argument so be sure to check it out. It echoes one of the Lynch Ryan founding tenets. When many of us got into this business, we did not come with insurance backgrounds. We felt at its core, managing injuries required a focus on the human event and not the dollars. We believed then and still believe now that if you took excellent care of the injured worker, got them quality medical care and helped them get well and back to work, the dollars would follow.
Smile – it’s March 20 – Did you know that March 20 is International Day of Happiness? Now you do. It’s also the first day or Spring, and if, like us, you wondered why Spring isn’t commencing on the usual March 21 date, Joe Rao at explains Why Spring Begins Early This Year.
New State Fund in Illinois?Illinois Bucks Trend in Other States; Looks to Establish Competitive Workers’ Comp State Fund – “Illinois state legislators are running counter to a national trend by proposing creation of a state workers’ compensation insurance fund that would compete with the private system. The development is generating deep angst amongst Illinois insurers and industry trade groups.”
Other state news

New Citizenship Verification form – As of 3-8-13, a revised US Citizenship & Immigration Service (USCIS) Verification Form I-9 has been issued. There is a 60-day grace period to come into compliance – new USCIS I-9 Formsforms must be in use by May 7, 2013.
When healthcare workers are unsafe, patient quality suffers – “Many medical work environments are unsafe for health professionals, adding stress and distraction that can expose patients to harm,” according Kevin B. O’Reilly who writes about a recent report by the National Patient Safety Foundation’s Lucian Leape Institute. In an article in entitled Warning sounded on demoralized health care work force, he cites a high injury rate that is 33% higher than private industry as one factor, as well as “the lingering problem of disruptive behavior in health care, which can create a culture of fear and intimidation that inhibits safe, high-quality care.”
Fatalities Report – The March Monthly Labor Review has a report on Hispanic/Latino fatal occupational injury rates (PDF). The fatality rate for Hispanic/Latino workers is much higher than that of other demographic groups. Studies also show that, “… foreign-born Hispanic/Latino workers have higher rates than native-born Hispanic/Latino workers in certain occupations, a statistic that is explainable by differentials in employment between the two groups.”
Worker Costs – According to the latest Department of Labor report, the Northeast leads the U.S. in worker costs. “Hourly costs per employee in the Northeast – which includes the New England states, New York, New Jersey and Pennsylvania – averaged $33.10 in December, higher than the national average of $28.89. The next costliest region was the West, which consists of the mountain and Pacific coast states, at $30.29. The average hourly wage in the Northeast was $22.85, while the average per-hour employer cost in benefits was $10.25, both the highest in the U.S.”
More news of note

Annals of Compensability: A Tale of Two Blisters

Monday, March 18th, 2013

Back in November we blogged the story of John Pearson, a diabetic whose tight workboots – provided by his Arkansas employer – caused a blister that led directly to diabetic neuropathy. The injury was deemed compensable under workers comp. Today we examine a similar blister saga involving Earl Sterling, a machinist for Eaton Corporation in Mississippi. Like Pearson, Sterling was diabetic, but his is a story with a grim outcome. When it comes to compensability, the devil is definitely in the details.
Once again, the story begins innocently with new boots. Sterling began wearing new steel-toed boots – required by his employer – in June 2008. His feet started throbbing immediately; within a week, a blister had developed. He took a week off, telling his supervisor that he had twisted his ankle: he did not report the blister problem. After the blister popped, Sterling sought treatment from his family doctor. Within three weeks of first putting on the boots, Sterling had developed a high fever and was delirious. During his hospitalization, he developed a staph infection, resulting in the amputation of his leg below the knee. By the end of the year, Sterling had reached maximum medical improvement and had been cleared for seated work.
Work Related?
In July 2008 Sterling filed for workers comp benefits, claiming the blister was the result of wearing the boots. But in the course of his testimony, numerous contradictions and inconsistencies emerged. His initial report only involved a swelling of his feet – nothing about a blister. Hospital records indicate that his diabetes was out of control for at least 90 days prior to hospital admittance. In his testimony, he was unclear about the exact nature of the blister: he stated it was on top of his fourth and fifth toes, but medical records indicated it was between the toes, where a friction blister is less likely to occur.
Given the inconsistencies, the administrative law judge denied the claim. The denial was upheld at the appeals level.
It turns out that Sterling’s family physician may have misdiagnosed – or at least mistreated – the diabetes: while two years prior to the injury, the doctor had given Sterling medications for regulating blood sugar, he mistakenly believed that Sterling’s current blood sugar levels were within normal ranges. They were not. Three physicians testified that the blister was a result of the swollen feet and Sterling’s uncontrolled diabetic condition and was independent of the wearing of steel-toed boots.
“Arising From and In the Course and Scope of Employment”
Thus we have two cases involving diabetes: one in which the co-morbidity leads to a work-related and compensable infection (Pearson), and one where the co-morbidity itself – and not the work-required boots – leads to the infection that ultimately requires an amputation (Sterling). Pearson is able to return to productive employment, supported every step of the way by the robust benefits of the workers comp system. Sterling finds himself without a job and without benefits, literally, without a leg to stand on.
In this tale of two blisters, one has a reasonably happy ending, the other does not. In the annals of compensability, eligibility for comp benefits is – in this particular case, at least – subject to the highly rigorous and presumably objective scrutiny of medical science. Sterling ultimately loses his case because his narrative is full of holes and his devastating condition apparently did not arise from and in the course of his work as a machinist.

Health Wonk Review, Compensability Challenges, Accommodations & More

Thursday, March 14th, 2013

Chewy Health Wonk Review – David Williams has posted Health Wonk Review: A Lot to Chew On at Health Business Blog. – and he is right, with the Affordable Care Act implementation proceeding, he notes that it is “the golden era for health wonks.” When you stop by David’s place, drop a note of congratulations – he is celebrating his 8 year blogiversary, which, in Internet years, is very old indeed.
CompensabilityRisk & Insurance features an interesting case study by Jared Shelly that deals with compensability as it relates to business travel in From Russia, Without Love. After his business was completed, 60-year-old American executive decided to see “the sights” in Moscow and mayhem ensued. Are injuries sustained in a shady barroom compensable? Click to see the adjuster’s decision. And for another interesting study in compensability: She got food poisoning in the company break room; does she get workers’ comp?
Accommodations – Jon Hyman of Ohio Employer’s Law Blog offers tips for what to do if you doubt an employee’s disability. It’s worth checking out – a Los Angeles waste disposal company made the wrong choices and was awarded $21.7 million by a jury.
Caveat Emptor – Sarah Kliff of Washington Post’s Wonkblog looks at how much anankele MRI costs in the D.C, area and finds that prices range from $400 to $1,861. She talks to John Driscoll, president of Castlight Health, a firm that studies and is dedicated to improving healthcare cost transparency.
Changing workforce – In the United States, 10,000 baby boomers reach 65 every day, and many retire, taking with them valuable experience, skills and loyalty to their employers. Ed Pound looks at global labor trends and the impact on the insurance industry in his article The Stagnant Labor Pool, which appears in this month’s Leader’s Edge.
Blankenship Addendum – earlier in the week, we posted about the ongoing criminal investigation into the UBB mine disaster. Since that posting, Ken Ward has updated his site with a transcript of proceedings which was recently made available.
Fraudster of the weekBoston Bus Driver Convicted In Staged Shooting. Her actual criminal conviction was not for the related workers’ comp, but for deliberately misleading an investigator, which is a felony under the state’s witness intimidation statute.
More News of Note

UBB mine disaster: the plot thickens as former CEO Blankenship implicated

Tuesday, March 12th, 2013

In the ongoing saga of the federal investigation into the April 2010 Upper Big Branch Mine Disaster that resulted in the deaths of 29 miners, things recently took a dramatic turn. The legal-criminal proceedings have resulted in four convictions to date. Now, in the most recent proceedings, a top Massey official has implicated former CEO Don Blakenship.

According to a news report by Ken Ward Jr in the Charleston Gazette:

Former Massey official David C. Hughart pleaded guilty to two federal criminal charges that he plotted with other company officials to routinely violate safety standards and then cover up the resulting workplace hazards.

But a fairly routine plea hearing here took a surprising twist when U.S. District Judge Irene Berger pressed Hughart to name his co-conspirators and Hughart responded, “the chief executive officer.”

Hughart did not use Blankenship’s name, but Blankenship was CEO of Massey from 2000 until 2010, during the period when the crimes Hughart admitted to committing occurred.

On his Coal Tattoo blog, Ward looks at media coverage this news generated and how it was reported. He talks about what’s next in the Upper Big Branch criminal probe. The prosecution has stated that “This is not the end of the investigation.”

You can follow Don Blankenship’s doings on his fairly new website, where he is self billed as “Native of Appalachia, Job Creator, CEO, and American competitionist.” He posts his thoughts about mine safety, among other things, in an essay page. In his page of media coverage, Ken Ward’s clips and the UBB mining investigations are unsurprisingly absent.
You can also follow his opinions and comments on Twitter at @DonBlankenship. Ironically, his most recent post accuses President Obama of lying, with a link to an essay which claims that Obama lied about climate change in his State of the Union address.

We’re coming up on the third anniversary of this terrible Massey mine tragedy. The investigation and criminal probe of company officials continues, but it’s important to look beyond that to ensure future safety. Ken Ward takes the MHSA to task for waiting 32 years to enforce the landmark mine safety act of 1977.

We point you to the Miners Memorial Page at the tribute site, Faces of the Mine. Scrolling through a page of 29 portraits brings home the enormity of this tragedy in a visceral way.

News from around the blogosphere: Risk roundup, transitions & other noteworthy items

Wednesday, March 6th, 2013

Risk Roundup – David Williams hosts Cavalcade of Risk #178: Little bit of everything edition over at Health Business Blog. David’s a good blog citizen – he’ll be hosting next week’s Health Wonk Review, too!
Transitions – Isaac Asimov said “The only constant is change.” We are pleased to see that Marsh has named Mark Walls Workers’ Compensation Market Research Leader. Kudos for Marsh – they will have a great champion in Mark, who has been a social media pioneer with his leadership in founding the ever-popular Work Comp Analysis Group. Hopefully, he’ll have room in his new role to do much more in this vein. And in another notable industry transition, we see the passing of the torch at California Workers’ Compensation Institute as J. Michael Nolan retires and Alex Swedlow takes the reins. Our colleague Joe Paduda does a nice job explaining why Swedlow’s appointment is such a smart move on CWCI’s part.
Mental Anguish – There’s currently a bill before Connecticut legislators that would expand workers’ comp to include post-traumatic stress under specific circumstances – think first responders and Newtown. Unsurprisingly, the Insurance Association of Connecticut is opposing the bill on the basis that the language and circumstances are too vague and it would undo many of the reforms put in place in 1993. The issue of stress, trauma and PTSD is a tough one in workers’ comp – and although CT has been spurred by the recent tragedy, it’s an issue that surfaces frequently with first responders. See: S.C. Police Traumatized By Shocking Work Left Out Of Worker’s Compensation.
Repeat offenders & government contracts – Should a company that repeatedly and willfully flouts OSHA safety standards be eligible for federal contracts? At The Pump Handle, Celeste Monforton posts this question about Houston-area excavation firm SER Construction Partners in light of a recent citation for for willfully failing to comply with standards for safe excavation practices. She documents that this is one in a series of violations – in two instances, workers died following serious injuries related to OSHA violations. Fines are pretty negligible for a large company — and as we’ve noted before, more often than not, fines are bargained down. There should be some more serious consequence for serial offenders — withholding state and federal contracts seems appropriate to us.
Good read – Don’t miss Dave DePaolo’s post, A word that’s both a noun and an adjective, on the role that language plays in the aftermath of a worker’s injury. In any other setting, they would be “a patient” rather than a claimant. We often fall back on industry jargon without thinking through the effect on others. A few years back, the managed care industry was raked over the coals for calling patients “covered lives.” Language matters. DePaolo identifies the jargon as a way to make things less personal – and that is likely true. All too often, workers comp is viewed more as a financial event than a human event, which it really is. Someone got injured. At Lynch Ryan, we’ve always found that if you take care of the human, first and foremost, the financial outcome is generally better too.
Safety – Sandy Smith has a thoughtful piece about Safety After the Fact in EHS Today. It’s the sad story of one worker’s injuries that led to his death at a too-young age. Simple safety procedures might have prevented the injury. In contrast, Steve Yahn has written an interesting profile of a company that appears to be doing things right — Cirque du Soleil’s risk management and safety program — in Risk & Insurance. They take a rigorous, multi-disciplinary approach to prevention.
Other Noteworthy News

Opioid Catastrophe: The Data Leads to Doctors

Monday, March 4th, 2013

After two stimulating days at the Workers Comp Research Institute conference, the Insider is ready to solve the opioid problem. To be sure, WCRI is a research-driven organization and makes no claims of solving problems; it simply reveals them through stark, powerful data. However, in a series of presentations ranging from improving the way doctors prescribe drugs through the mobilization of entire communities to tackle the problem, the conference has illuminated the path toward a favorable resolution of this increasingly dire problem.
Dr. Karin Mack of the Centers for Disease Control established the parameters of the problem: death from drug overdoses – mostly involving prescribed medications – now kills more people than traffic accidents. While heroin and cocaine account for about 4,000 deaths annually, opioids kill four times as many people – more than 16,000 in 2010. Most of the drug overdoses involved people of working age (between early 20s and 60). Dr. Mack identified the population most at risk:
– “Doctor shoppers”
– People receiving high daily doses of opioids and those using a variety of drugs
– Low income people and those living in rural areas
– Medicaid populations
– People with mental illness or a history of substance abuse
When the discussion shifted specifically to workers comp, the data becomes even more alarming. In some states, over 80% of injured workers receive opioids for pain relief – way too many! The prescribed doses are often much higher than is medically necessary. For many workers, the prescriptions extend for many weeks, even though pain usually subsides relatively quickly. And finally, very few doctors are monitoring patients who have been prescribed opioids.
Doctor Problems
Given that drug abuse has reached catastrophic proportions, and given that most of the problem involves prescribed – as opposed to illicit – medications, it is becoming increasingly clear that doctors are a big part of the drug problem. They are too quick to prescribe opioids; they prescribe them for too long; and they fail to monitor injured workers who are on these medications. The first red flag, in other words, is raised over the heads of our medical practitioners.
Dr. Dean Hashimoto outlined a Massachusetts initiative that significantly reduced doctor mistakes in prescribing opioids (a summary of the state’s approach can be found here). The guidelines:
1. Distinguish between acute and chronic pain. For acute pain, doctors should explore ady and all alternatives before prescribing opioids and then carefully re-evaluate before extending the initial prescription.
2. For chronic pain [in itself a red flag], doctors should run urine screens to determine whether the prescribed drug is being used properly and whether other drugs have been taken; they should meet fact to face with patients as frequently as needed; and they should try to focus on function rather than pain.
Note that these are steps that doctors should, but all-too-often don’t take. Combine that with the fact that a small number of doctors are generally responsible for a huge number of prescriptions: in California, 3% of doctors prescribe over 50% of the opioids. Once again, doctors are at the root of the drug problem.
In addition to improving best practices in the medical use of opioids, we need to know more about prescription practices. This involves the evolving tool of prescription drug monitoring programs (PDMPs), which track prescription practices of doctors across a given state. Because the programs are state based, they vary widely on how they work: what is tracked, how often data is submitted, how it is analyzed and what is done with it. Ideally, to be effective, the data should be collected on a real-time basis, but in practice, it’s generally submitted weekly. Ideally, there should be standards across all state PDMPs: everyone collecting the same data, in the same form, generating information on prescription practices and “hot spots” with consistency.
Brandeis University’s Center for Excellence identifies the best practices for PDMAs. But we live in an age where uniform standards are anathema. It’s just not going to happen, so we’ll have to live with the current chaos – which, however inadequate, is better than nothing.
Community Mobilization
While there is much that can and should be done at the doctor-patient level to fix the opioid problem, such efforts cannot solve the problem. We can actually map the crisis across the country and identify specific communities that have been devastated by drug abuse. The conference highlighted efforts in eastern Kentucky, where in some counties half the children are being raised with no parents in the home (the parents being dead from overdoses, incapacitated by addiction or in prison). Under Operation UNITE, the community has responded with a combination of drug enforcement, coordinated treatment, support for families and friends of abusers, education and mentoring for young adults. They teach kids archery and fishing, among other things, surely an example of putting the beautiful natural surroundings to good use.
It is hardly surprising that one focus of UNITE is the pill mills that are frequently found in poor, rural areas. One doctor prescribed over 100,000 pills a month (!) by issuing 40-50 scripts each day (!). Don’t bother asking whether Dr. Hashimoto’s standards of treatment were followed.
The Path to a Cure
The WCRI conference illuminates the path toward solving the opioid abuse catastrophe: teach doctors how and when to use these powerful drugs and how to find alternative treatment forms; carefully monitor injured workers on opioids to ensure proper use; severely limit the use of these drugs over the long term; monitor prescription practices to identify doctors who are not with the program; and provide support, mentoring and education to young people in high risk communities.
There are many obstacles to implementing a comprehensive and effective program, but in those areas where key elements have been established, the incidence of opioid abuse has been dramatically reduced. It is ironic, of course, that the stakeholders who must “do no harm” are in fact in the forefront of the problem. They can and must do better. Medicine got us into this mess and it is medicine, with its highly trained and presumably well-intentioned practitioners, that must lead the way out.